Provider Demographics
NPI:1609049550
Name:SCOTT, DANA MICHELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HONEYSUCKLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1156
Mailing Address - Country:US
Mailing Address - Phone:334-836-1212
Mailing Address - Fax:334-836-1888
Practice Address - Street 1:480 HONEYSUCKLE ROAD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-3001
Practice Address - Country:US
Practice Address - Phone:334-836-1212
Practice Address - Fax:334-836-1888
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095387363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health